Hydrothermal synthesis of novel heterostructured Ag/TiO2 /CuFe2 O4 nanocomposite: Characterization, enhanced photocatalytic degradation of methylene blue dye, and efficient antibacterial studies

In this work, we reported the successful synthesis of novel Ag/TiO₂ /CuFe₂ O₄ ternary nanocomposite by hydrothermal technique by using TiO₂ /CuFe₂ O₄ binary nanocomposite precursor that was also prepared by hydrothermal treatment by using TiO₂ nanoparticles and CuFe₂ O₄ nanoparticles synthesized via sol-gel method. The synthesized nanomaterials were accessed for their morphological, structural, and optical properties. X-ray diffraction (XRD) study reveals the formation of pure Ag/TiO₂ /CuFe₂ O₄ ternary nanocomposite in which the Ag, TiO₂ , and CuFe₂ O₄ are in anatase, spinal, and cubic crystal phases, respectively. Transmission electron microscopy (TEM) and high-resolution TEM (HRTEM) analyses of Ag/TiO₂ /CuFe₂ O₄ ternary nanocomposite indicated granule-shaped morphology with bright spots of silver. The existence of Ti, O, Cu, Fe, and Ag without any other elements in the energy-dispersive X-ray spectroscopy (EDS) spectra of the prepared ternary nanocomposite depict its purity and its polycrystalline nature was confirmed by its selected area electron diffraction (SAED) pattern. The ternary nanocomposite was utilized for the methylene blue dye degradation with an optimum dose of 1.00 g/100 ml under ultraviolet (UV) light; the enhanced photocatalytic activity of the composite is attributed mainly due to the appreciable magnitudinal difference of positive charge of the valence band and negative charge of the conduction band of TiO₂ and CuFe₂ O₄ ; meanwhile, the interfacially placed Ag acts as a sink for the elections. Also, the ternary nanocomposite showed satisfactory antibacterial activities. PRACTITIONER POINTS: The prepared ternary nanocomposite showed effective results in dye degradation and satisfactory antibacterial property. The concentration of methylene dye has decreased considerably in every degradation process which was accessed through UV-vis studies. The highest degradation by using the ternary nanocomposite archived at pH = 6 Appreciable antibacterial activity was achieved against a few Gram-positive strains and Gram-negative strains of bacteria. This research activity can open a broad area of research towards textile dye degradation and antibacterial studies.

Utilization of epilepsy surgery in the United States: A study of the National Inpatient Sample investigating the roles of race, socioeconomic status, and insurance

Background:

Epilepsy is estimated to affect 70 million people worldwide and is medically refractory in 30% of cases.

Methods:

This is a retrospective cross-sectional study using a US database from 2012 to 2014 to identify patients aged ≥18 years admitted to the hospital with epilepsy as the primary diagnosis. The sampled population was weighted using Healthcare Cost and Utilization Project guidelines. Procedural ICD-9 codes were utilized to stratify the sampled population into two cohorts: resective surgery and implantation or stimulation procedure.

Results:

Query of the database yielded 152,925 inpatients, of which 8535 patients underwent surgical intervention. The nonprocedural group consisted of 76,000 White patients (52.6%) and 28,390 Black patients (19.7%) while the procedural group comprised 5550 White patients (64%) and 730 Black patients (8.6%) (P < 0.001). Patients with Medicare were half as likely to receive a surgical procedure (14.8% vs. 28.4%) while patients with private insurance were twice as likely to receive a procedure (53.4% vs. 29.3%), both were statistically significant (P < 0.01). Those in the lowest median household income quartile by zip code (<$40,000) were 68% less likely to receive a procedure (21.5% vs. 31.4%) while the highest income quartile was 133% more likely to receive a procedure (26.1% vs. 19.5%). Patients from rural and urban nonteaching hospitals were, by a wide margin, less likely to receive a surgical procedure.

Conclusion:

We demonstrate an area of need and significant improvement at institutions that have the resources and capability to perform epilepsy surgery. The data show that institutions may not be performing enough epilepsy surgery as a result of racial and socioeconomic bias. Admissions for epilepsy continue to increase without a similar trend for epilepsy surgery despite its documented effectiveness. Race, socioeconomic status, and insurance all represent significant barriers in access to epilepsy surgery. The barriers can be remedied by improving referral patterns and implementing cost-effective measures to improve inpatient epilepsy services in rural and nonteaching hospitals.

Resolution of tardive tremor after bilateral subthalamic nucleus deep brain stimulation placement

Background:

Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of referrals for the evaluation of idiopathic Parkinson disease. There are reports of successful treatment of tardive orofacial dyskinesia and dystonia with deep brain stimulation (DBS) using globus pallidus interna (GPi) as the primary target, but the literature on subthalamic nucleus (STN) DBS for tardive dyskinesia (TD) is lacking. To the best of our knowledge, there are no reports on DBS treatment of TT.

Case Description:

A 75-year-old right-handed female with the medical history of generalized anxiety disorder and major depressive disorder had been treated with thioridazine and citalopram from 1980 till 2010. Around 2008, she developed orolingual dyskinesia. She was started on tetrabenazine in June 2011. She continued to have tremors and developed Parkinsonian gait, both of which worsened overtime. She underwent DBS placement in the left STN in January 2017 with near-complete resolution of her tremors. She underwent right STN implantation in September 2017 with similar improvement in symptoms.

Conclusion:

While DBS-GPi is the preferred treatment in treating oral TD and dystonia, DBS-STN could be considered a safe and effective target in patients with predominating TT and/or tardive Parkinsonism. This patient saw a marked improvement in her symptoms after implantation of DBS electrodes, without significant relapse or recurrence in the years following implantation.

Acquired Holmes Tremor in a Human Immunodeficiency Virus Immune Reconstitution Inflammatory Syndrome Patient Treated with Deep Brain Stimulation

BACKGROUND

The authors present a case of a 66-year-old male who was diagnosed with human immunodeficiency virus, and his medical course of highly active antiretroviral therapy was complicated with the development of immune reconstitution inflammatory syndrome, which led to development of movement disorder consisting of right-sided resting tremor, neck dystonia, and jaw clenching.

CASE DESCRIPTION

The patient's symptoms resembled that of rubral tremor, and he underwent placement of a deep brain stimulation electrode into the left ventral intermediate nucleus of the thalamus with significant improvement of symptoms.

CONCLUSIONS

This is the first reported case in the literature of a human immunodeficiency virus-positive patient's treatment course complicated with immune reconstitution inflammatory syndrome with neurologic manifestation, which was refractory to medical therapy and thus treated with deep brain stimulation.

Safety of the transventricular approach to deep brain stimulation: A retrospective review

Background:

Anatomically, deep brain stimulation (DBS) targets such as the ventral intermediate and subthalamic nucleus are positioned such that the long axis of the nucleus is often most accessible through a transventricular trajectory. We hypothesize that using this trajectory does not place patients at increased risk of neurologic complications.

Methods:

A series of 206 patients at a single institution between 2000 and 2017 were reviewed. All patients had a confirmed transventricular trajectory and their clinical course was reviewed to assess neurologic complication rates in the postoperative period.

Results:

The average length of hospital stay was 2.4 days. The most common neurologic complication was altered mental status in 1.2% of cases (four patients). This was followed by seizure in 0.6% of cases (two patients). No patients had ischemic stroke or postoperative hemiparesis. There were two mortalities in this series, one with lobar hemorrhage contralateral from the surgical site and one with a thalamic hemorrhage. There was only one confirmed intraventricular hemorrhage postoperatively; however, this was clinically asymptomatic.

Conclusion:

Although the total incidence of intraventricular or intracerebral hemorrhage cannot be reliably assessed from this data set, the low incidence of neurologic complications challenges the notion that DBS electrode trajectories that transgress the ventricle significantly increase the risk of complications.

Infections in Deep Brain Stimulator Surgery

Introduction: Deep brain stimulation has emerged as an effective treatment for movement disorders such as Parkinson’s disease, dystonia, and essential tremor with estimates of >100,000 deep brain stimulators (DBSs) implanted worldwide since 1980s. Infections rates vary widely in the literature with rates as high as 25%. Traditional management of infection after deep brain stimulation is systemic antibiotic therapy with wound incision and debridement (I&D) and removal of implanted DBS hardware. The aim of this study is to evaluate the infections occurring after DBS placement and implantable generator (IPG) placement in order to better prevent and manage these infections.

Materials/Methods: We conducted a retrospective review of 203 patients who underwent implantation of a DBS at a single institution. For initial electrode placement, patients underwent either unilateral or bilateral electrode placement with implantation of the IPG at the same surgery and IPG replacements occurred as necessary. For patients with unilateral electrodes, repeat surgery for placement of contralateral electrode was performed when desired. Preoperative preparation with ethyl alcohol occurred in all patients while use of intra-operative vancomycin powder was surgeon dependent. All patients received 24 hours of postoperative antibiotics. Primary endpoint was surgical wound infection or brain abscess located near the surgically implanted DBS leads. Infections were classified as early (<90 days) or late (>90 days). Infectious organisms were recorded based on intra-operative wound cultures. Number of lead implantations, IPG replacements and choice of presurgical, intra-operative, and postsurgical antibiotics were recorded and outcomes compared.

Results: Two hundred and three patients underwent 391 electrode insertions and 244 IPG replacements. Fourteen patients developed an infection (10 early versus 4 late); 12 after implantation surgery (3%) and 2 after IPG replacement surgery (0.8%). No intracranial abscesses were found. Most common sites were the chest and connector. Staphylococcus aureus (MSSA) was the most common organism. Intra-operative vancomycin powder did not decrease infection risk. Vancomycin powder use was shown to increase risk of infection after electrode implantation surgery (Relative Risk 5.5080, p = 0.02063). Complete hardware removal occurred in eight patients, one patient had electrode only removal, three patients with I&D and no removal of hardware, and two patients with removal of IPG and extensor cables only. All patients were treated with postoperative intravenous antibiotics and no recurrent infections were found in patients with hardware left in place.

Discussion/Conclusion: Infections after DBS implantation and IPG replacement occurred in 3% and 0.8% of patients respectively in our study which is lower than reported historically. Early infections were more common. No intracranial infections were found. Intra-operative use of vancomycin was not shown to decrease risk of infection after electrode implantation surgery or IPG replacement. However, in our study it was shown to increase risk of infection after electrode implantation surgery. Treatment includes antibiotic therapy and debridement with or without removal of hardware. DBS hardware can be safely left in place in select patients who may have significant adverse effects if it is removed. 

The Effect of the Modified Endoscopic Lothrop Procedure on the Mucociliary Clearance of the Frontal Sinus in an Animal Model

Background

The surgical management of recalcitrant frontal sinus disease has been a dilemma for otolaryngologists for many years. Although the osteoplastic flap with obliteration has been the gold standard of treatment for years, the modified endoscopic Lothrop (MEL) procedure recently has been advocated as an alternative. However, little is known about the effect of this procedure on the mucociliary drainage of the frontal sinuses postoperatively and this animal study addresses this issue.

Methods

Fourteen sheep underwent the MEL procedure. The sheep were randomized regarding the use of postoperative irrigation via minitrephines. Each sheep had a nuclear medicine γ-scintigraphy frontal sinus clearance study via minitrephines performed on each frontal sinus preoperatively and then 3 months postoperatively. Then, the results of these studies were compared.

Results

The scans revealed a trend toward faster clearance times postoperatively. However, this decrease was not statistically significant. Importantly, there was no trend or significant increase in clearance times postoperatively. Also, the use of postoperative irrigation was associated with a nonsignificant trend toward faster clearance times postoperatively.

Conclusion

The MEL procedure has no adverse effects on the mucociliary clearance of the frontal sinus at 3 months postoperatively. Irrigation of the frontal sinus in the immediate postoperative period showed a trend toward improved postoperative mucociliary function at 3 months.

A novel haemostatic agent based on self-assembling peptides in the setting of nasal endoscopic surgery, a case series

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A novel purely synthetic topical haemostatic agent is proposed for use in endonasal surgery.

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The mechanism is based on the self-assembling tendency of four repeating peptide sequences.

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The haemostatic agent was used in 60 patients undergoing endonasal powered turbinoplasty.

•

Routine post-operative followup at 4 weeks has shown no re-bleeding or adhesion formation in all 60 patients.

•

Pending further research, the agent shows promise in endonasal surgery as both a haemostatic and anti-adhesive adjunct.

Introduction

Recently, a novel purely synthetic topical haemostatic agent (PuraStat^®) has been proposed in surgery based on the self-assembling tendency of some repeating peptide sequences. This transparent, ready to use hydrogel appears suitable for use in FEES with low rates of post-operative re-bleeding and adhesion formation.

A first series of 60 patients experiencing endonasal powered turbinoplasty across various hospitals in Sydney using PuraStat^® was observed for postoperative re-bleeding and adhesion formation.

Discussion

In all 60 patients, no post-operative re-bleeding was observed, while healing went well in absence of adhesion formation. Effective haemostasis with PuraStat^® is well documented in other surgical fields, but its use in FEES and adhesion prevention is relatively novel.

Conclusion

Synthetic self-assembling peptides appear to be indicated in this area. Further studies are needed to confirm their potential for adhesion prevention.

Elective Use of Veno-venous Extracorporeal Membrane Oxygenation and High-flow Nasal Oxygen for Resection of Subtotal Malignant Distal Airway Obstruction

We describe the use of peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO) and high-flow nasal oxygen as procedural support in a patient undergoing debulking of a malignant tumour of the lower airway. Due to the significant risk of complete airway obstruction upon induction of anaesthesia, ECMO was established while the patient was awake, and was maintained without systemic anticoagulation to minimise the risk of intraoperative bleeding. This case illustrates that ECMO support with high-flow nasal oxygen can be considered as part of the algorithm for airway management during surgery for subtotal lower airway obstruction, as it may be the only viable option for maintaining adequate gas exchange.

Frontal ostium neo-osteogenesis and restenosis after modified endoscopic Lothrop procedure in an animal model

All patients who undergo a modified endoscopic Lothrop procedure have postoperative narrowing of the enlarged frontal ostium. The aim of this study is to evaluate neo-osteogenesis and restenosis of the frontal ostium and its effect on mucociliary clearance. Fourteen sheep underwent an endoscopic modified Lothrop procedure. Pre- and postoperative nuclear medicine gamma scintigraphy of the frontal sinuses was performed. The sizes of the frontal ostia were measured and biopsies taken from the bone of the frontal ostium. Histological evidence of new bone formation was found in 56% of biopsies. The average preoperative mucociliary clearance half times (T1/2) at 15 and 30 min were 70 and 74 min, respectively, and postoperatively were 50 and 67 min. There was a non-significant trend towards poorer clearance in sinuses with neo-osteogenesis. The average size of the frontal ostium decreased by 28%. There was no relationship between the size of the ostium and neo-osteogenesis. Neo-osteogenesis was seen in 56% of biopsies with a 28% reduction in size of the frontal ostium after 224 days. Mucociliary clearance did not alter significantly.

The effect of the modified endoscopic Lothrop procedure on the mucociliary clearance of the frontal sinus in an animal model

BACKGROUND

The surgical management of recalcitrant frontal sinus disease has been a dilemma for otolaryngologists for many years. Although the osteoplastic flap with obliteration has been the gold standard of treatment for years, the modified endoscopic Lothrop (MEL) procedure recently has been advocated as an alternative. However, little is known about the effect of this procedure on the mucociliary drainage of the frontal sinuses postoperatively and this animal study addresses this issue.

METHODS

Fourteen sheep underwent the MEL procedure. The sheep were randomized regarding the use of postoperative irrigation via minitrephines. Each sheep had a nuclear medicine gamma-scintigraphy frontal sinus clearance study via minitrephines performed on each frontal sinus preoperatively and then 3 months postoperatively. Then, the results of these studies were compared.

RESULTS

The scans revealed a trend toward faster clearance times postoperatively. However, this decrease was not statistically significant. Importantly, there was no trend or significant increase in clearance times postoperatively. Also, the use of postoperative irrigation was associated with a nonsignificant trend toward faster clearance times postoperatively.

CONCLUSION

The MEL procedure has no adverse effects on the mucociliary clearance of the frontal sinus at 3 months postoperatively. Irrigation of the frontal sinus in the immediate postoperative period showed a trend toward improved postoperative mucociliary function at 3 months.

The modified endoscopic Lothrop procedure in the treatment of complicated chronic frontal sinusitis

The purpose of this study was to evaluate the modified endoscopic Lothrop procedure in the management of complicated frontal sinus disease which has breached the confines of the sinus walls and extended into the cranial cavity or orbit. Fourteen patients with radiological evidence of 17 complications of frontal sinus disease presented over a 23-month period. CT scan and MRI scans revealed the presence of posterior table erosion and extension of the frontal sinus disease into the anterior cranial fossa in 10 patients. In addition, seven patients had intraorbital complications, with three patients having both intracranial and orbital complications. All patients underwent a modified endoscopic Lothrop procedure as part of the management of the complication. In addition, one patient required an orbital abscess drainage and repair of an encephalocele, with a second patient requiring drainage of an orbital subperiosteal abscess. At follow-up, all patients were asymptomatic and had patent frontal sinus ostia. Follow-up ranged from 8 months to 38 months with a median of 25 months. Three patients required a revision of their frontal ostium. Two patients had allergic fungal sinusitis with aggressive polyp recurrence and ostial re-stenosis while one patient developed recurrent orbital infections from a retained frontal sinus cell. Currently, all have patent ostia, with an average size of 14.6 x 11 mm. The modified endoscopic Lothrop procedure is an effective form of treatment in the management of complicated frontal sinus disease. The results are comparable to those achieved with other surgical approaches such as the osteoplastic flap with obliteration.

The frequency, antecedent events, and causal relationships of neurologic worsening following severe head injury. Executive Committee of the international Selfotel Trial

Neurologic deterioration observed following head injury is recognized as having a deleterious effect on outcome. The present study examines this occurrence in detail to determine the frequency of these episodes, their antecedent events and causal relationships in order to identify patients who are at risk. Data was collected prospectively from a consecutive series of 427 patients entered into the international trial of the NMDA receptor antagonist Selfotel. Using a definition of neurologic worsening based upon objective criteria, 117 patients were identified who suffered 164 episodes of deterioration. The occurrence of a single episode of neurologic worsening increased mortality by more than five-fold and reduced favorable outcomes (good or moderate on the Glasgow Outcome Scale), by more than 50%. Increased intracranial volume resulting in intracranial hypertension was the single most frequent cause of neurologic worsening. This serves to emphasize the importance of more adequate treatments of intracranial hypertension in improving the outcome of patients with severe head injury.